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Texas Children’s Health Plan wants members and their parents to know and understand all of their health care rights and responsibilities.

Your rights
You have the right to get accurate, easy-to-understand information to help you make good choices about your child's health plan, doctors, hospitals and other providers.

• Your health plan must tell you if it uses a "limited provider network." This is a group of doctors and other providers who only refer patients to other doctors who are in the same group. In a network like this, you can’t see all the doctors who are in your health plan. If your health plan uses "limited networks," you should check to see that your child's primary care provider and any specialist doctor you might like to see are part of the same "limited network."
• You have a right to know how your doctors are paid. Some get a fixed payment no matter how often you visit. Others get paid based on the services they give to your child. You have a right to know what those payments are and how they work.
• You have a right to know how the health plan decides whether a service is covered and/or medically necessary. You have the right to know about the people in the health plan who decide those things.
• You have a right to know the names of the hospitals and other providers in your health plan and their addresses.
• You have a right to pick from a list of health care providers that is large enough so that your child can get the right kind of care when your child needs it.
• If your child is confirmed to have special health care needs or a disability, you may be able to use a specialist as your child's primary care provider. Ask your health plan about this.
• Children who are confirmed to have special health care needs or a disability have the right to special care.
• If your child has special medical problems, and the doctor your child is seeing leaves your health plan, your child may be able to continue seeing that doctor for three months, and the health plan must continue paying for those services. Ask your plan how this works.
• Your daughter has the right to see a participating obstetrician/gynecologist (OB/GYN) without a referral from her primary care provider and without first checking with your health plan. Ask your plan how this works. Some plans may make you pick an OB/GYN before seeing that doctor without a referral.
• You have a right to emergency services when you need them if you reasonably believe your child's life is in danger, or that your child would be seriously hurt without getting treated right away. Coverage of emergencies is available without first checking with your health plan. You may have to pay a few dollars depending on your income. This is called a “copay.”
• You have the right and responsibility to take part in all the choices for your child's health care.
• You have the right to speak for your child in all treatment choices.
• You may have a right to get a second opinion from another doctor in your health plan about what kind of treatment your child needs.
• You have the right to be treated with respect and kindness when you visit a doctor’s office, go to the hospital or talk to your health plan.
• You have the right to be treated fairly by your health plan, doctors, hospitals and other providers.
• You have the right to talk to your child's doctors and other providers in private, and to have your child's medical records kept private. You have the right to look over and copy your child's medical records and to ask for changes to those records.
• You have the right to a fair and quick process for solving problems with your health plan and the plan's doctors, hospitals and others who provide services to your child. If your health plan says it won’t pay for a covered service or benefit that your child's doctor thinks is medically necessary, you have a right to have another group, outside the health plan, tell you if they think your doctor or the health plan is right.

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Your responsibilities
You and your health plan both have an interest in seeing your child’s health improve. You can help by assuming these responsibilities:

• Try to follow healthy habits, for example, encourage your child to exercise, to stay away from tobacco and to eat a healthy diet.
• Become involved in the doctor’s decisions about your child’s treatments.
• Work together with your health plan's doctors and other providers to pick treatments for your child that you all have agreed.
• If you have a disagreement with your health plan, try first to resolve it using the health plan's complaint process.
• Learn about what your health plan does and does not cover. Read your member handbook to understand how the rules work and how you can try to change health plan choices that you don’t like.
• Show respect for other families and for the people who are trying to help your child.
• If you make an appointment for your child, try to get to the doctor’s office on time. If you can’t keep the appointment, be sure to call and cancel it.
• Remember to pay your doctor and other providers what you owe them. Keep track of what you pay.
• Report misuse of the CHIP program by health care providers, other CHIP members or CHIP health plans.

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